Fuyang Medical Insurance Bureau: Digitization is used to "do practical things"

China has the largest basic medical security system in the world. From the arrival of newborn babies to maternity insurance and work-related injury insurance, all It is related to the work of the Medical Insurance Bureau.

Among them, the work of the Municipal Medical Insurance Bureau is To manage all designated hospitals and pharmacies for medical insurance in the city, Assess service quality, allocate funds, publicize medical insurance policies, and regularly review qualifications; At the same time Provide medical insurance convenience services for insured residents, such as medical insurance consultation and special medical insurance treatment review.

"Take Fuyang Medical Insurance Bureau as an example It faces more than 1000 designated medical insurance pharmacies, more than 2000 designated medical institutions, and nearly 10 million insured units and residents. " Kong Lingqi, chief of the Information Section of Fuyang Medical Insurance Center, told us.

In order to improve service quality, Fuyang Medical Insurance Bureau has built a set of smart medical insurance handling service platform on the basis of enterprise WeChat.

Do not allow business handling to "break the leg"

In the past, monthly medical insurance expense settlement was handled offline. The staff of hospitals and pharmacies should sort out the bills, print them and send them to the settlement department of the medical insurance center. The medical insurance center shall allocate funds according to regulations after reconciliation and review; If the account is found to be unbalanced, repeat it. Fuyang Medical Insurance Bureau has to review the bills of more than 3000 institutions and allocate millions of funds every month. This work is very tedious, but it cannot be slow or wrong.

Not only medical insurance expense settlement, medical insurance access, agreement online signing and other work, but also offline in the past.

Now everyone has mobile phones, can these things be handled online?

However, considering the high cost of developing a special system to cover all the designated hospitals and pharmacies for medical insurance in the city, and it will take a long time to promote it, everyone hesitated.

At that time, many government units were using enterprise WeChat to work, and Fuyang Medical Insurance Bureau found that Enterprise WeChat can also connect companies.

"The upstream and downstream functions of enterprise WeChat can enable us to connect with designated hospitals and institutions of medical insurance, and also integrate systems and applications. As long as hospitals and pharmacies are connected to the upstream and downstream of enterprise WeChat, we can communicate on it and share the same system, and the cost is much lower than that of building a system by ourselves," Kong said.

Therefore, Fuyang Medical Insurance Bureau has created a "smart medical insurance handling service platform", which is connected to the enterprise WeChat workbench.

Now, when medical insurance is settled, hospitals and pharmacies can directly fill in expense declaration information on enterprise WeChat, The staff of the medical insurance bureau can complete the information review online, and then feed the results back to the hospital and pharmacy online. If it passes the review, it shall allocate funds in accordance with relevant regulations in a timely manner; If they fail, they can also give reasons online and give adjustment suggestions. People in hospitals and pharmacies don't have to run errands again and again; With the help of the system, the staff of the medical insurance bureau no longer need to manually review each order, which is convenient and standardized.

Why not directly develop an official website of the medical insurance bureau and put all the functions on it?

“ The focus is on the confirmation of identity information. WeChat has its own address book ， And everyone has their own job information in it, which can better ensure information security. If it is a web page, you should also set an account and password for each staff member, and manually add and clear permissions for staff turnover. "

"And, Most designated hospitals and pharmacies have already used enterprise WeChat for internal office and external services, So we don't need to spend much energy on publicity ， Let everyone register enterprises and micro enterprises without going to teaching. Naturally, nearly 2000 designated institutions were quickly brought in. "

After using enterprise WeChat, the cooperation between the medical insurance bureau and designated hospitals and pharmacies is much more convenient.

However, there are also various processes and approvals within the medical insurance bureau. How to improve the effectiveness?

"Fuyang Medical Insurance Bureau also has 9 county and district level medical insurance centers, which have business needs such as dynamic insurance participation of special personnel, core system business authorization, information change, etc Approval. These things should be marked, The original plan was to run errands offline one by one, or take photos with seals, pass them around, or It's too slow to arrange, or you can't find it when you turn around. "

Therefore, Fuyang Medical Insurance Bureau All internal approvals of the organization are put into the "Approval" function on the enterprise WeChat workbench. The approval process of enterprise and micro enterprise can be flexibly set, and the order of approvers can be set in advance; The person who approves will receive a reminder on the mobile phone to complete the approval. All relevant materials can be archived without fear of expiration, and data security has also been improved.

Special medical insurance application cycle

For chronic and special diseases, the state has always had special medical insurance benefits.

For example, chronic diseases such as hypertension and diabetes usually do not require hospitalization, but only regular outpatient treatment. However, the treatment cycle is long and the cost is high, which will bring considerable economic burden to the sick.

In order to reduce the pressure on patients, the Medical Insurance Bureau has specially opened special medical insurance channels so that they can enjoy lower reimbursement threshold, higher ceiling and reimbursement ratio and other welfare policies. After the insured residents have confirmed the relevant diseases, they can declare the treatment of outpatient chronic and special diseases.

Previously, patients often felt "long process, many nodes and time-consuming" when making relevant declarations. This is because patients need to take paper diagnostic materials from the hospital and go to the medical insurance center to submit them. According to the national requirements, the medical insurance bureau should organize a unified review every month, package all application materials to professional doctors for identification, and enter them into the system if they meet the standards. The medical insurance bureau that does not meet the standards should return the application, and then explain the reasons for rejection to patients.

A month seems to be a short time, but many patients will feel a long time if they have to repeat the process if the material preparation is not standardized.

"Chronic diseases and special diseases are small probability events, but the number of insured population is also large, which adds up to nearly 10 million. For the medical insurance bureau, our monthly review work is not less stressful, and we understand that patients have to wait for a long time. In fact, many diseases are easy to determine, so there is no need to let patients wait for a month." Kong told us.

How can we avoid the "back and forth running" of the masses and make the audit more efficient?

Since Fuyang Medical Insurance Bureau has made all processes online through enterprise WeChat, it has become easier for insured residents to apply for medical treatment for chronic and special diseases.

"Now, if the patient is diagnosed in the designated hospital for medical insurance, The diagnosis doctor can directly issue a signature certificate, and then take a photo of all the materials on the doctor's mobile phone, and upload them to the 'smart medical insurance handling service platform' through the enterprise and micro enterprise for declaration. Relevant staff of the medical insurance bureau can directly approve on the background system through the enterprise and micro enterprise It will be finished in one or two working days. ”

Examination and approval of medical insurance benefits for chronic and special diseases, From one month to one day, this is a microcosm of Fuyang Medical Insurance Bureau's digital convenience and benefit. Since the platform was launched last year, Fuyang Medical Insurance Bureau has assisted more than 1500 insured people to complete online application and approval of treatment for chronic and special diseases. Not only the approval of treatment for chronic and special diseases, With the help of enterprise WeChat, Fuyang Medical Insurance Bureau has handled more than 9700 demands of insured people so far.

Fuyang Medical Insurance Bureau found that many residents would like to directly consult the medical insurance bureau when they encounter medical insurance problems, so, The medical insurance bureau has access to "WeChat customer service" on the official public account, where residents can directly inquire. For example, the most direct and accurate answers will be given to common questions such as "how to reimburse for childbirth", "reimbursement proportion and limit of general outpatient services", etc. If the residents do not get satisfactory answers, the manual customer service can also answer one-on-one questions.

Medical insurance policy publicity

For the municipal medical insurance bureau, another extremely important task is to accurately publicize various policies of the medical insurance bureau or the municipal government to the designated hospital pharmacies, For example, the basic medical insurance fund structure, the specific treatment of the insured people, and the particularly complex medical insurance information business coding standards. Hospital pharmacies can better serve and answer questions for all insured units and residents only if they have an accurate understanding of these contents.

In the past, these messages were mainly delivered through various group chats, but they were not convenient.

“ There is too much news. If we don't read it immediately, we will be drowned in group chat; I didn't look carefully at it at that time, but I came to ask us when we met some problems, and the news accumulated more and more, Many of our staff members are also very depressed. Many organizations come to ask you many questions that you have answered many times. The policy is highly professional and can't be explained clearly in one or two sentences, so communication is very difficult; But we must answer every question carefully, because if you don't explain clearly, it is likely that those insured people under their window will not be able to enjoy medical insurance treatment normally. "

How can we do a good job in policy publicity and Q&A and improve efficiency?

Fuyang Medical Insurance Bureau has built an "online knowledge base" on enterprise WeChat. This "knowledge base" can find all the past health insurance related publicity policies, national health insurance standards, management regulations, as well as common questions and answers. The content is also classified and neat according to the various functional modules of medical insurance for easy reference. The staff of the designated hospital pharmacy can find this knowledge base by opening the enterprise WeChat, Quickly find what you want to know according to the directory.

"Moreover, policies from the past for a long time to the latest can be found quickly; unlike being thrown into a group, it is difficult for them to find materials that are a little bit old. Now we have greatly reduced the number of repeated answers to questions about medical insurance policies and standards, and the number of question answering groups is 60% less than in the past. "

"Digitalization can't be a pretence. The starting point of all our work is the real needs of the masses and business, and it is to do practical things." Kong Lingqi, chief of the Information Section of Fuyang Medical Insurance Center, said.

Reviewing the digitalization process of Fuyang Medical Insurance Bureau, their ideas are simple and direct, which is to solve the current problems one by one and really do practical things for the groups they manage and serve.

Under the general trend of digital innovation of government services, many government departments are actively exploring new changes. Digitization will also always accompany front-line government workers to do a good job of grassroots services.